Recurrence, progression of periodontitis and tooth loss associated with surgical or non-surgical procedures in periodontal maintenance therapy: An overview

Abstract

The benefits of periodontal maintenance therapy (PMT) in maintaining the homeostasis of periodontal tissues obtained after active periodontal therapy, which includes surgical and non-surgical procedures, has been extensively documented in numerous studies. A classic problem in PMT programs is difficulty in maintaining the patient's cooperation and in scheduling regular maintenance visits. However, without establishing a regular program of clinical re-evaluation, adequate biofilm control, and reinforcement of oral hygiene instructions, the benefits of PMT cannot be maintained. Several indicators or risk factors and biological, behavioral, and social conditions can influence the periodontal status of individuals undergoing PMT. Moreover, neglecting a regular PMT program has been associated with a higher risk of recurrence and with the progression of periodontitis. In this chapter, smoking, diabetes, and poor oral hygiene were strongly associated with recurrence, progression of periodontitis and tooth loss in individuals under PMT. The efficiency of surgical and non-surgical periodontal procedures in the context of periodontal therapy has been widely reported. Review studies on surgical or nonsurgical periodontal therapy have concluded that: (a) the comparison of the efficacy of surgical and nonsurgical procedures revealed that scaling and root planing alone or in combination with flap procedures are effective methods for the treatment of chronic periodontitis; (b) the consistent message is that in treating deep pockets, open-flap debridement results in greater probing pocket depth reduction and clinical attachment gain than nonsurgical modalities; (c) Nonsurgical modalities in shallower pockets consistently involve less post-therapy recession and are clearly recognized as being more conservative. Additionally, recurrence of periodontitis and tooth loss has been reported in studies in the absence of periodontal treatment, as well as in many PMT retrospective and prospective studies. However, these results have been very controversial, primarily related to the type of surgical or non-surgical procedures performed during PMT. In this sense, several issues related to the recurrence, progression of periodontitis and tooth loss during periodontal maintenance therapy require clarification. The aim of this chapter is to review the periodontal literature and summarize the main findings of different study designs, in attempt to a greater understanding of the influence of risk factors associated with surgical or non-surgical procedures performed during periodontal maintenance therapy on the occurrence of these adverse outcomes. © 2013 Nova Science Publishers, Inc. All rights reserved.